Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 2 Advantages and disadvantages of bladder drainage of the exocrine secretions

Advantages

Safety

Reduced infection rate because of relative sterility of lower urinary tract

Control of anastomosis by urethral catheter decompression

Technical considerations

Relative simplicity because of favorable anatomic location of bladder

Bladder mobilization permits tension-free, multi-layer anastomosis

Bladder vasculature and urothelium promote healing

Direct access to exocrine secretions for monitoring pancreas allograft function

Detection of rejection by urinary parameters (amylase, lipase, insulin, cytology)

Cystoscopic access for either duodenal or pancreatic parenchymal biopsy

Disadvantages

Urologic problems

Hematuria, dysuria, cystitis, urethritis, urethral stricture or disruption, balanitis

Increased risk of lower urinary tract infections, stone formation, and urine leaks (either from bladder or duodenum)

Metabolic and volume problems

Dehydration, orthostasis, constipation, erythrocytosis

Metabolic acidosis

Miscellaneous problems

Reflux-associated hyperamylasemia or pancreatitis

Transitional cell (urothelial) dysplasia

Need for enteric conversion for refractory, persistent, or recurrent problems

Medication burden (massive amounts of bicarbonate supplementation)